Management of peritonitis in automated peritoneal dialysis patients

The management of peritonitis in patients undergoing automated peritoneal dialysis (APD) deserves special consideration due to the technical differences between APD modalities and continuous ambulatory peritoneal dialysis (CAPD). The use of very short exchanges may preclude the prompt diagnosis of peritonitis by diluting the peritoneal-cell population and causing spuriously low cell counts and clear effluent. Very long diurnal cycles can have the opposite result and give a falsely elevated cell count. The effluent from the multiple automated exchanges must be visually examined before being discarded in order to make a prompt diagnosis. Direct drainage of effluent into the sewage without inspection should be avoided. If direct drainage becomes a common practice, other alternatives such as on-line cell counters or chemical detectors of possible infection will be necessary. The recommendations for antimicrobial therapy developed for CAPD apply as well to APD. If single-day dosage is to be used, the longer exchanges of APD are ideal for intra-peritoneal delivery of antibiotics.